High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study.
30-days mortality
acute heart failure
prognosis
troponin
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
15
01
2020
revised:
05
04
2020
accepted:
12
04
2020
pubmed:
20
4
2020
medline:
24
3
2021
entrez:
20
4
2020
Statut:
ppublish
Résumé
Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable. The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality. The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis. Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results. An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.
Sections du résumé
BACKGROUND
BACKGROUND
Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable.
OBJECTIVES
OBJECTIVE
The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality.
METHODS
METHODS
The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis.
RESULTS
RESULTS
Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results.
CONCLUSIONS
CONCLUSIONS
An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.
Substances chimiques
Troponin T
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13248Subventions
Organisme : Fundació la Marató de TV3
ID : 2015/2510
Organisme : Instituto de Salud Carlos III
ID : PI15/00773
Organisme : Instituto de Salud Carlos III
ID : PI15/01019
Investigateurs
Marta Fuentes
(M)
Cristina Gil
(C)
Héctor Alonso
(H)
Pablo Garmila
(P)
Esther Rodríguez-Adrada
(E)
Guillermo Llopis-García
(G)
Rosa Escoda
(R)
Carolina Xipell
(C)
Carolina Sánchez
(C)
Josep Mª Gaytan
(JM)
María José Pérez-Durá
(MJ)
Eva Salvo
(E)
José Pavón
(J)
Antonio Noval
(A)
José M Torres Murillo
(JM)
María Luisa López-Grima
(ML)
Amparo Valero
(A)
Mª Angeles Juan-Gómez
(MA)
Alfons Aguirre
(A)
Maria Àngels Pedragosa
(MÀ)
Maria Isabel Alonso
(MI)
Francisco Ruiz
(F)
José Miguel Franco-Sorolla
(JM)
Elena Diaz
(E)
Ana Belén Mecina
(AB)
Josep Tost
(J)
Susana Sánchez
(S)
Virginia Carbajosa
(V)
Pascual Piñera
(P)
Raquel Torres-Garate
(R)
Miguel Alberto Rizzi
(MA)
Sergio Herrera
(S)
Antonio Haro
(A)
Irene Cabello
(I)
Macarena Dastis
(M)
Claudia Elisabeth Imperiali
(CE)
Alex Roset
(A)
Fernando Richard
(F)
José María Álvarez Pérez
(JM)
Maria Pilar López-Diez
(MP)
Belén Prieto
(B)
Joaquin Vázquez
(J)
Marta Sánchez-Gonzalez
(M)
José Juan Gil-Román
(JJ)
Víctor Marquina
(V)
Inmaculada Jiménez
(I)
Néstor Hernández
(N)
Ana López
(A)
Patricia Javaloyes
(P)
Juan Antonio Andueza
(JA)
Rodolfo Romero
(R)
Roberto Calvache-Arranz
(R)
Mª Teresa Lorca Serralta
(MT)
Luís Ernesto Calderón
(LE)
Beatriz Amores-Arriaga
(B)
Beatriz Sierra-Bergua
(B)
Enrique Martín-Mojarro
(E)
Lisette Travería
(L)
Lluís Llauger
(L)
Gerard Corominas-LaSalle
(G)
Carmen Agüera-Urbano
(C)
Ángel Gutiérrez-García
(Á)
Ester Soy Ferrer
(ES)
Rut Gaya
(R)
Desiree Wussler
(D)
Eleni Michou
(E)
Joan Walter
(J)
Ivo Strebel
(I)
Christian Mueller
(C)
Informations de copyright
© 2020 Stichting European Society for Clinical Investigation Journal Foundation.
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